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BackgroundGroin hernia management has a significant worldwide diversity with multiple surgical techniques and variable outcomes. The International guidelines for groin hernia management serve to help in groin hernia management, but the acceptance among general surgeons remains unknown. The aim of our study was to gauge the degree of agreement with the guidelines among health care professionals worldwide.MethodsForty-six key statements and recommendations of the International guidelines for groin hernia management were selected and presented at plenary consensus conferences at four international congresses in Europe, the America’s and Asia. Participants could cast their votes through live voting. Additionally, a web survey was sent out to all society members allowing online voting after each congress. Consensus was defined as > 70% agreement among all participants.ResultsIn total 822 surgeons cast their vote on the key statements and recommendations during the four plenary consensus meetings or via the web survey. Consensus was reached on 34 out of 39 (87%) recommendations, and on six out of seven (86%) statements. No consensus was reached on the use of light versus heavy-weight meshes (69%), superior cost-effectiveness of day-case laparo-endoscopic repair (69%), omitting prophylactic antibiotics in hernia repair, general or local versus regional anesthesia in elderly patients (55%) and re-operation in case of immediate postoperative pain (59%).ConclusionGlobally, there is 87% consensus regarding the diagnosis and management of groin hernias. This provides a solid basis for standardizing the care path of patients with groin hernias.

Introduction Colorectal cancer (CRC) is one of the most frequent malignancies worldwide. There is a global trend in the increase of CRC incidence in younger patients. Our objective is to perform a comparative analysis of CRC in younger patients (˂45 years) and in older patients (≥ 45 years) in a sub-Saharan African country. Methods Over a period of 5 years, we retrospectively included patients diagnosed with CRC at our Pathology service. We performed statistical comparisons of clinicopathological features between young and older patients with CRC, and searched for risk factors associated with the occurrence of CRC in young patients. Results We identified 173 cases of CRC, ranking as the third most common cancer. The mean age was 49 years ± 16.1 (range of 15–84 years), with young patients representing 39.9% (69 cases). Compared to older patients, CRC was more frequent in young females (43.5% versus 28.8%, P  = 0.048). Also, CRC in young patients was often associated with mucinous or signet ring cell (SRC) carcinoma histological differentiation (21.7% versus 5.8%, P  = 0.002). Although CRC tended to present in more advanced stages (stages III – IV) in young patients, the difference failed to reach statistical difference (47.6% versus 39.5%, P  = 0.596). In univariate logistic regression analysis, female sex (Odds ratio (OR) = 1.9, P  = 0.049) and mucinous/SRC histological differentiation (OR = 4.59, P  = 0.003) were risk factors associated with the occurrence of CRC in young patients. Conclusion Colorectal cancer is a frequent malignancy in our country, affecting a substantial proportion of young persons, emphasizing the need for earlier screening. Young patients with CRC present with adverse clinicopathological features in comparison to older patients.

Clandestine abortion remains a prevalent health concern in developing countries, often resulting in severe complications, including uterine secrosis with generalized peritonitis necessitating life‐saving hysterectomy, which results in permanent infertility. A 18‐year‐old primigravida patient presented to our department with severe abdominal pain and vaginal bleeding following a clandestine abortion attempt, 15 days prior. Furthermore, the patient exhibited symptoms of uncontrollable vomiting and diarrhea that began 4 days prior to admission. Upon further examination, she was diagnosed with peritonitis. We performed an emergency laparotomy. It was discovered that the uterus was necrotic and that the foetus was in the abdominal cavity with its placenta. A hysterectomy was necessary to save the patient's life, resulting in permanent infertility. The patient's postoperative course was uncomplicated, and she was discharged from hospital on the 12th day after surgery. This case highlights the need for political and medico‐social actions facilitating access to sexual and reproductive education and to voluntary termination of pregnancy in a legal and medicalized context in our regions. Key Clinical Massage In developing countries, clandestine abortion remains a prevalent issue, often resulting in misdiagnosis, severe uterine necrosis and generalized peritonitis. This can necessitate hysterectomy with permanent infertility. It is important for practitioners to be able to identify this situation when it arises, even when the serum β‐human chorionic gonadotropin level is normal.

Background Intussusception is a rare condition in adults, accounting for 5% of intestinal intussusception and being responsible for approximately 1% of all adult bowel obstructions. Neoplastic origin is the most common etiology of intestinal intussusception in adults, unlike pediatric intussusception, which is usually idiopathic. Intussusception due to the appendiceal mucocele is exceptional, and only a few cases have been reported in the medical literature. Case presentation We report the case of a 25-year-old black African male patient with no medical history. He presented to the emergency department for abdominal pain, nausea, and bilious vomiting. The abdominal examination revealed typical signs of acute bowel obstruction. Enhanced abdominopelvic computed tomography showed an invagination of the last ileal loop, cecum, and ascending colon into the lumen of the transverse colon, with a rounded image with hypodense content and some calcifications compatible with an appendiceal mucocele. An emergency exploratory laparoscopy was performed and confirmed the ileocecocolic intussusception. Right hemicolectomy and ileocolic anastomosis were performed. The patient recovery postoperatively was uneventful, and he was discharged 4 days later. Histological examination of the surgical specimen confirmed the diagnosis of mucinous cystadenoma. Conclusion The symptoms of bowel intussusception with the appendiceal mucocele as the lead point in adults are similar to any other bowel intussusception. Differential diagnosis is often carried out thanks to the injected abdominal computed tomography scan.

Objective To report the diagnostic and therapeutic approach for the management of abdominal masses in the General Surgery department of the Niamey General Reference Hospital (HGR). Materials and methods This were a retrospective and preliminary study of 2 years and 3 months on patients operated for abdominal masses in the General Surgery department of the HGR. A palpable mass and/or its size on imaging (40 mm) were the inclusion criteria. Results Abdominal masses accounted for 6.7% ( n  = 53) of other pathologies. The average age of the patients was 41.26 years, with a standard deviation of 14.2 and a female predominance of 75.5% ( n  = 40) with a sex ratio of 0.32. The abdominal mass was clinically palpable in 75.5% ( n  = 40). Abdominal pelvic ultrasound was performed as a first step in all patients and in 75.5% ( n  = 40) it specified the origin of the mass. Contrast-enhanced abdomino-pelvic CT scan, performed in 52.8% of patients ( n  = 28) and in 89.3% ( n  = 25) specified the preoperative diagnosis. The most frequent etiologies were uterine fibroids, 35.8% ( n  = 19). In 5.6% ( n  = 3) the diagnosis was not precise preoperatively despite the two imaging studies, and these patients had underwent exploratory laparotomy. Surgery was the initial therapeutic approach for all patients, and laparoscopy accounted for 22.6% ( n  = 12). Postoperative complications occurred in 7.5% ( n  = 11). The death rate was 5.6% of cases ( n  = 3). Conclusion Imaging remains important in the etiological research for abdominal masses. Definitive treatment remains surgical; mortality would be linked to the malignant nature and the significant volume of the mass.

Typhoid intestinal perforation (TIP) is a life-threatening, late complication of typhoid fever that disproportionately impacts children in low resource settings and continues to have devastating consequences worldwide. Despite elimination of typhoid fever in most high income countries, typhoid fever and TIP remain endemic in many countries around the world as a result of inadequate investments in water, sanitation, and hygiene (WASH) and lack of access to vaccines. A first National Typhoid Conference was held in Niamey, Niger on July 22, 2023, where surgeons and other medical and health professionals from Niger convened with local and international health professionals to discuss their experiences with TIP and advocate for better prevention and treatment of the disease. The high number of intestinal perforations diagnosed during surgery, and the lack of capacity for performing blood cultures motivated surgeons in Niger to convene and share data on complications of typhoid, epidemiology, and diagnosis. TIP, a leading cause of peritonitis in Africa, often results in emergency surgery and has reported mortality rates up to 30% in pediatric patients. The availability of four safe and effective typhoid conjugate vaccines, two with committed financial support from Gavi, the Vaccine Alliance, makes prevention through vaccination a realistic near-option for typhoid fever to complement improvements in WASH.

Introduction Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) is characterized by congenital aplasia of the uterus and upper 2/3 of the vagina, with normal female secondary sexual characteristics and a normal karyotype (46, XX). The frequency is 1/4500–5000 female births. The aim of this study was to report the management of MRKH syndrome with sigmoid vaginoplasty. Patients and method This study included 4 patients recruited over a 4-year period from February 2016 to January 2019. MRKH syndrome was retained in the presence of normal secondary sexual characteristics with normal external genitalia associated with vaginal aplasia and uterine agenesis. The approach was a laparotomy and a perineal approach under general anesthesia. The procedure involved the removal of a sigmoidal colonic graft that was anastomosed with the vaginal dimple. Results The average age was 23 years. All patients had consulted for primary amenorrhea, infertility, and/or difficulties in sexual intercourse. The diagnosis of MRKH type 1 was retained in all patients. The average length of the vagina was 3.25 cm before surgery and 13.63 cm after surgery. The postoperative outcomes were uneventful in 3 patients. One patient developed anastomotic stenosis that was successfully treated with vaginal dilation for 2 weeks. The average postoperative follow-up was 30 months. Conclusion In the context of a low-resource setting, sigmoid transposition represents a good procedure to treat vaginal aplasia and restore a satisfactory sexual activity to patients with MRKH type 1.

Background Pyelo-ureteral junction syndrome (PUJS) is a frequent congenital malformation. We report the surgical management of PUJS by pyeloplasty according to Anderson-Hyne-Kuss’s procedure at the Zinder National Hospital.. Methods This was a retrospective study from January 2013 to December 2016 (4 years), including patients who have undergone surgery for PUJS. Results Twelve (12) cases of PUJS had a surgery among which 66.7% were men with an average age of 32.5 ± 7.6 years. The clinical symptomatology was lumbar pain or renal colic in 92.3% of cases. This pain had evolved for more than 2 years for 58.3% of the cases. Ultrasound coupled with intravenous urography or CT-scan was performed to confirm the diagnosis of PUJS in 58.3 and 41.7% of cases. The average serum creatinine level at admission was 181.25 ± 67.3 μmol/L [Lab reference range: 53–97 μmol/L]. The Anderson-Hynes non dismembered pyeloplasty is used for all the patients. The release of a crossing lower pole vessel was performed in 25%, pyelolithotomy in 16.7%. The average surgery time was 118.3 ± 20.7 min. The average hospital length of stay was 10.8 ± 3 days. Immediate postoperative complications were recorded in 33.3% ( n  = 4). Postoperative outcomes were considered good by disappearance of clinical, biological and radiological signs. Conclusion The Anderson-Hynes non dismembered pyeloplasty gives good results and provides a successful alternative in an environment where laparoscopy and robotic surgery are not developed.

Surgical care needs in low-resource countries are increasingly recognised as an important aspect of global health, yet data for the size of the problem are insufficient. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) is a population-based cluster survey previously used in Nepal, Rwanda, and Sierra Leone. Using previously published SOSAS data from three resource-poor countries (Nepal, Rwanda, and Sierra Leone), a weighted average of overall prevalence of surgically treatable conditions was estimated and the number of deaths that could have been avoided by providing access to surgical care was calculated for the broader community of low-resource countries. Such conditions included, but were not limited to, injuries (road traffic incidents, falls, burns, and gunshot or stab wounds), masses (solid or soft, reducible), deformities (congenital or acquired), abdominal distention, and obstructed delivery. Population and health expenditure per capita data were obtained from the World Bank. Low-resource countries were defined as those with a per capita health expenditure of US$100 or less annually. The overall prevalence estimate from the previously published SOSAS data was extrapolated to each low-resource country. Using crude death rates for each country and the calculated proportion of avoidable deaths, a total number of deaths possibly averted in the previous year with access to appropriate surgical care was calculated. The overall prevalence of surgically treatable conditions was 11·16% (95% CI 11·15–11·17) and 25·6% (95% CI 25·4–25·7) of deaths were potentially avoidable by providing access to surgical care. Using these percentages for the 48 low-resource countries, an estimated 288·2 million people are living with a surgically treatable condition and 5·6 million deaths could be averted annually by the provision of surgical care. In the Nepal SOSAS study, the observed agreement between self-reported verbal responses and visual physical examination findings was 94·6%. Such high correlation helps to validate the SOSAS tool. Hundreds of millions of people with surgically treatable conditions live in low-resource countries, and about 25% of the mortality annually could be avoided with better access to surgical care. Strengthening surgical care must be considered when strengthening health systems and in setting future sustainable development goals. None.

Introduction. Intra-abdominal testicular torsion is a rare event. We report hereby our experience of the management of a spermatic cord twist on intra-abdominal testis discovered during an acute surgical abdomen. Case Presentation. This was a 42-year-old patient admitted to the emergency department for abdominal pain that had been evolving for a week. The physical examination showed tenderness and guarding in the left iliac fossa with an empty ipsilateral hemiscrotum. Complementary examinations led to the discovery of an intra-abdominal left-lateral mass. The laparotomy found a whitish mass with areas of infarction, which was resected. Anatomopathological examination of the operative specimen identified it as a testis with atrophy of germ cells and necrotic areas without evidence of malignancy. Conclusion. Intra-abdominal testicular torsion should be considered in case of patients with an acute surgical abdomen with vacuity of one of the bursae.